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Tricuspid regurgitation duration correlates with cardiovascular magnetic resonance-derived right ventricular ejection fraction and predict prognosis in patients with pulmonary arterial hypertension

 In-Jeong Cho  ;  Jaewon Oh  ;  Hyuk-Jae Chang  ;  Junbeom Park  ;  Ki-Woon Kang  ;  Young-Jin Kim  ;  Byoung-Wook Choi  ;  Sanghoon Shin  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Jong-Won Ha  ;  Namsik Chung 
Journal Title
Issue Date
Cardiac-Gated Imaging Techniques* ; Echocardiography ; Exercise Test ; Female ; Heart Rate/physiology ; Humans ; Hypertension, Pulmonary/physiopathology* ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Stroke Volume/physiology ; Systole ; Tricuspid Valve/physiopathology* ; Tricuspid Valve Insufficiency/diagnosis* ; Tricuspid Valve Insufficiency/physiopathology* ; Ventricular Dysfunction, Right/diagnosis* ; Ventricular Dysfunction, Right/physiopathology*
Prognosis ; Pulmonary arterial hypertension ; Right ventricular function
AIMS: Right ventricular (RV) failure is known to be the main cause of mortality and is closely related to prognosis in patients with pulmonary arterial hypertension (PAH). A decrease in the duration of tricuspid regurgitation corrected for heart rate (TRDc) has recently been shown to be associated with advanced RV failure and poor clinical outcomes. The aim of the present study was to investigate whether TRDc correlates with RV parameters assessed using cardiovascular magnetic resonance (CMR) and has prognostic significance in patients with PAH. METHODS AND RESULTS: Thirty-seven consecutive patients with PAH (28 females, age 46 ± 14 years) underwent a 6 min walk test, right heart catheterization, echocardiography, and CMR within a 48 h period. Tricuspid regurgitation duration corrected for heart rate, tricuspid annular plane systolic excursion (TAPSE), Tei index, and tricuspid valve lateral annular systolic velocity were measured on echocardiography, and RV end-systolic and end-diastolic volumes and ejection fraction were measured on CMR. Tricuspid regurgitation duration corrected for heart rate was positively correlated with RV ejection fraction as measured on CMR (r = 0.400, P = 0.014). On multivariate regression analysis, TRDc was also significantly correlated with RV ejection fraction even after adjusting for the eccentric index, Tei index, and TAPSE (P = 0.034). During a median follow-up period of 487 days, there were seven events (19%) including two cardiac deaths and five inpatient admissions for heart failure. The event-free survival rate was significantly higher for patients with TRDc >400 ms than those with TRDc ≤400 ms (P = 0.040). CONCLUSION: Tricuspid regurgitation duration corrected for heart rate correlated with CMR-derived RV ejection fraction, and decreased TRDc was associated with cardiovascular mortality and rehospitalization in patients with PAH. Therefore, TRDc could be a useful echocardiographic surrogate marker for predicting RV dysfunction and prognosis in patients with PAH.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ki Woon(강기운)
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Park, Jun Beom(박준범)
Shin, Sang Hoon(신상훈)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Cho, In Jeong(조인정)
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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